Healthcare Provider Details

I. General information

NPI: 1528481835
Provider Name (Legal Business Name): AGAPE HOME HEALTH OF SC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2014
Last Update Date: 01/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1053 CENTER ST
WEST COLUMBIA SC
29169-6749
US

IV. Provider business mailing address

1053 CENTER ST
WEST COLUMBIA SC
29169-6749
US

V. Phone/Fax

Practice location:
  • Phone: 803-454-0365
  • Fax: 803-404-6000
Mailing address:
  • Phone: 803-454-0365
  • Fax: 803-404-6000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number461901
License Number StateSC

VIII. Authorized Official

Name: MS. ANN MASON HARRINGTON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 803-454-0365